Sports Medicine Feature

Putting the Wrong Foot Forward

Biloine W. Young • Fri, December 23rd, 2016

Many coaches have held that the midfoot strike—landing on the ball of the foot—is better and creates less force through the body. Now a study by Western Australia's Curtin University, that used sound and 3D motion technology to measure the impact and load of the different running styles of 26 participants, has altered that perception.

The participants were first asked to run “normally.” Then they were asked to run “quietly” to see if the force exerted on their joints also “lightened.”

Following instructions, the participants changed to a forefoot strike when they were trying to run quietly. The sound was reduced but the force was not. It was simply shooting through the body in a different way.

"Using a rear-foot and forefoot strike technique changes the loads experienced by the joints and muscles when running which can pre-dispose you to certain types of injuries, " said lead author Leo Ng, M.D. "Forefoot strike runners are at greater risk of Achilles-type injuries while rear-foot runners are more likely to get knee pain."

Running Coach Damon Bray agrees that there is no ideal style. “Look at the Olympics with the very best runners together, " he said. "Not one of them will run exactly the same. They'll try to apply the same principles but will, in essence, move differently."

Bray disagrees with the advice to change footwear or strike pattern. "Suggesting runners, especially recreational runners, could or should ditch supportive running shoes and try barefoot or nearly non supportive shoes will in my opinion cause a high degree of injury.”

One Response to “Putting the Wrong Foot Forward”

A hundred thousand years ago—that is, pre-pavement, running without your supportive running shoes was pretty normal. You also wore out and were gone by age 40, and foot and leg damage was the least of your worries.

Fast forward to today. Our legs and feet were not designed for flat, hard pavement with little or no variation and the constant steady impact of running on it.

Wear good supportive shoes…or go run barefoot (or nearly so) in the fields and forests like your ancestors and avoid the pavement…and the lions, tigers and bears.

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New Study Finds Running With Soft Footfalls Reduces Injury

Tracey Romero • Mon, March 19th, 2018

A study conducted by The Hong Kong Polytechnic University recently found that novice distance runners running with softer footfalls can reduce the risk of injury by 62%.

Roy Cheung, Ph.D., associate professor of the department of rehabilitation sciences at The Hong Kong Polytechnic University, conducted a gait retraining program on injury prevention to investigate why running injuries have been on the rise.

According to a press release, this is the first randomized controlled trial to prove how modifying running posture with a systemic training method can prevent running injuries.

Cheung and his team collected data for a year on 320 novice runners who are 18 to 50 years old and who had less than two years of running experience and compared the results. Each of the runners run more than 8 km per week.

Of these 320 runners, 166 of them received two weeks of visual biofeedback training (the gait retraining group) in the lab during eight treadmill-training sessions. While on the laboratory treadmill, these runners were reminded via a monitor to run softer. The control group, the other 154 runners, didn’t receive any feedback while running on the treadmill in the lab. They ran their normal stride during the whole session.

Cheung and his team found that while on their own it was hard for runners to detect whether they are landing soft or hard, with the visual biofeedback training they were able to effectively change their gait when they were signaled to do so.

Before and after the gait retraining program, the researchers measured landing forces via the vertical average loading rate (VALR) and vertical instantaneous loading rate (VILR) of both groups at slow (8 km/h) and fast (12 km/h) paces. Both are biomechanical markers related to injury.

According to the data, the VALR and VILR in the gait retraining group was reduced after the retraining from 65.9 BW/s (body weight per second) to 54.8 BW/s and 90.7 BW/s to 75.0 BW/s at slow pace; and from 81.3 BW/s to 66.6 BW/s and 111.9 BW/s to 94.8 BW/s at fast pace. In the control group, no significant differences were found in VALR at slow pace after training, but VALR at fast pace and VILR at both testing speeds were slightly increased.

Building Foot Abs, an Unconventional Approach to Foot Injury

Tracey Romero • Tue, June 13th, 2017

Move over abdominal muscles, you are not the only core muscles in our body that need strengthening. At the recent American College of Sports Medicine annual meeting in Denver, Colorado, Irene S. Davis, Ph.D., PT, FACSM, FAPTA, FASB, professor in the department of physical medicine and rehabilitation at Harvard Medical School and director of the Spaulding National Running Center shared her unconventional approach to treating plantar fasciitis and Achilles tendinitis which includes strengthening the foot core and spending more time barefoot.

“Our feet are amazing with their 26 bones, 33 joints, 20+ muscles and 4 layers of arch muscles and they play an important role in both static posture and dynamic activities,” she said during her presentation.

Davis who is also known as the “Barefoot Running Professor” referred to a 2004 Nature article by Dennis M. Bramble, Ph.D., University of Utah and Daniel E. Lieberman, Ph.D., Harvard University, which described how humans evolved into endurance runners about 2 million years ago, but said that today we are not living the lives our bodies are evolved for.

“The environment is changing faster than our bodies can adapt and what we eat, the air we breathe and our activity level are the cause of many illnesses today including diabetes, obesity, cardiovascular disease as well as musculoskeletal injuries,” she said.

Davis argued that most running injuries are related to faulty mechanics and not necessarily overtraining and that the best chance runners have to be injury-free is to run barefoot or at the very least in minimal footwear in order to strengthen the foot and ankle.

Plantar fasciitis, a degenerative condition of the fascia overlying the plantar is one of the most common running injuries and according to Davis results from the excessive deformation of the arch. Current rehabilitation guidelines however just focus on supporting the foot with orthotic devices instead of training the muscles to perform the way they are supposed to. And in the case of Achilles tendinitis, which is caused by repetitive or intense strain on the Achilles tendon, she said, we need to focus on strengthening the tendon.

Runner’s Footstrike May Predict Injuries

Biloine W. Young • Mon, April 29th, 2013

Does the way a runner’s foot strikes the ground affect the number of runner’s injuries he or she may get? A recent study by Al Daoud and colleagues at Harvard University indicates that it may. According to Rich Sauza, writing in RunSafe, Daoud compared the difference between rearfoot strike and forefoot strike on the types and rates of injuries experienced by runners. His subjects were 52 male and female high-level intercollegiate track and cross country runners who were competing in distances ranging from 800 meters to 10 kilometers. All of the runners were either rearfoot or forefoot strikers.

The researchers observed that rearfoot strikers had more knee and hip injuries while the forefoot strikers had more ankle injuries. The rearfoot strikers tended to develop repetitive injuries and hip and knee injuries at a rate that was twice as often as forefoot strikers. Females with a forefoot strike were more likely to develop Achilles tendinopathy, but males were not. However, females with a rearfoot strike were more likely to develop plantar fasciitis. Sauza reported that males did not follow the same trend.

When comparing runners across a variety of common overuse running injuries, including knee pain and IT (Iliotibial) band syndrome, rearfoot-strikers were 2-3 times more likely to have problems than were the forefoot strikers. Sauza noted that, because of the small sample, these differences were not statistically significant. However, researchers note that this is one of the first studies to provide evidence that a particular strike pattern predisposes runners to more injuries.

Running at the Beach Is a Whole New Kettle of Fish

Sophie Bodek • Mon, July 21st, 2014

Running is popular. In fact, so many weekend athletes pound the pavement/sand that from an orthopedic perspective it’s becoming a Monday morning annuity for sports medicine docs.

Seventy percent of both recreational and competitive runners experience an overuse injury over a 12-month period. Knee injuries are most frequent and make up 42% of all running injuries—17% of running injuries consist of foot or ankle issues, 13% are made up of lower leg injuries, and the remaining 11% are hip or pelvis problems. To reduce the risk of injury, most runners employ a variety of preventative measures and techniques.

Running on the beach, however, poses a whole new set of challenges for runners.

As summer nears its peak, people often venture to the beach for fun and relaxation. Fortunately, running is an activity that can be enjoyed most anywhere and many choose to continue their workouts on the sand. Sand forces a change on the runner’s biomechanics which, most commonly, induces tightness in the lower leg muscles. Dr. Brian Dawson, DPM at Manhattan Footcare and Brighton Beach Orthopedics shares his knowledge about running by the sea.

"While arguably easy on the knees, running in the sand puts excess strain on many of the muscles and tendons of the lower extremity, for even the most fit runners, " Dawson quoted in the Ravelle Worthington article for Fitbie.com.

Working in conjunction with a physical therapist, sports chiropractor, and orthopedist, Dawson developed a set of techniques to minimize the risk of sand running injuries. First of all, adopt a forefoot to mid-foot strike. Heel strike first produces strain along the posterior muscle group when the heel sinks in the sand.

Second, run close to the waves. Running along the shoreline prevent strains because wet sand is more tightly packed and provides a more solid running surface.

Third, maintain those strong core muscles and stretch before running at the beach. Specifically, maintaining strong abdominal and back muscles keep all those musculoskeletal moving parts aligned and curved the right way. Finally, stretching builds flexibility, relieves soreness after a run, and reduces the risk of injury.

Dawson emphasizes thoroughly stretching the calf, hamstring, and quad before the beach run.

New Study: Shoes Healthier Than Barefoot Running

Biloine W. Young • Tue, July 5th, 2016

For years runners have debated the merits of what they wore on their feet. Some recommended running barefoot. Others argued that shoes’ spongy soles helped runners cope with the rough concrete of roads and trails. Others believed that the running shoes were somehow amplifying the body’s natural spring-like steps.

A new study, conducted by researchers at the University of Queensland, outfitted 16 volunteers with intramuscular electrodes that recorded the muscle activity in their feet. The wired volunteers ran—both barefoot and with running shoes—on a treadmill equipped with force sensors. According to Ars Technica science writer Beth Mole the researchers “paid particular attention to the runners’ muscles in their longitudinal arches, which have a natural spring-like action, bending as the foot lands and recoiling on the lift.”

When the study participants wore shoes, their arches did not bend as much. In fact they bent about 25% less than when the runners ran barefoot. This finding appeared to support those in favor of running shoes who believed that good shoes cushion each strike of the foot.

Skeptics disagreed, claiming that arch support diminishes the use of the muscle which leads to muscle weakness and eventual atrophy. Not so. Researchers found that arch muscles were working harder when runners wore shoes than they did when they were barefoot.

According to Mole, to make sense of their data, the researchers drew on results from experiments in which researchers stimulated muscles with electrical zaps and found that the muscles in the foot work as a unit, not individually. They hypothesized that with arch support from the shoe, the foot muscles had to work harder to match the extra stiffness in the system. They found that the best scenario was when running shoes act as a spring that works in concert with the runners’ feet. The shoes stiffened the foot’s natural springiness, rather than acting like an independent shock absorber.

The researchers in this study are aware that their work did not produce the final answer on how best to run. Mole reports that the data hints that running shoes have benefits. Maintaining leg stiffness during running is something bodies innately try to do.